Human factors in healthcare: welcome progress, but still scratching the surface

January 27, 2016

Source: BMJ Quality and Safety 2015/0 pp. 1-5

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Date of publication:  November 2015

Publication type:  Journal article

In a nutshell:  This article investigates the adoption of human factors and ergonomics (HFE) principles within healthcare settings in the UK and the US.  By considering the history, evolution and spread of HFE, the authors hope to enhance translation into healthcare lessons from industry, such as aviation, oil and gas and rail transport, to promote the integration of HFE into healthcare and improve quality of care and patient safety.

Length of publication:  5 pages


Improving health care quality and safety: the role of collective learning

December 23, 2015

SourceDove Press 2015/7 pp. 91—107

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Date of publication:  November 2015

Publication type:  Journal article

In a nutshell:  Despite decades of effort to improve quality and safety in health care, this goal feels increasingly elusive. Successful examples of improvement are infrequently replicated. This scoping review synthesizes 76 empirical or conceptual studies (out of 1208 originally screened) addressing learning in quality or safety improvement, that were published in selected health care and management journals between January 2000 and December 2014 to deepen understanding of the role that collective learning plays in quality and safety improvement. The review highlights the importance of leadership in both promoting a supportive learning environment and implementing learning processes.

Length of publication:   17 pages


Continuous improvement of patient safety: the case for change in the NHS

November 25, 2015

Source:  The Health Foundation

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Date of publication: November 2015

Publication type:  Report

In a nutshell: This report synthesises the lessons from the Health Foundation’s work on improving patient safety. Part I illustrates why improving safety is so difficult and complex, and why current approaches need to change. Part II looks at some of the work being done to improve safety and offers examples and insights to support practical improvements in patient safety. In Part III, the report explains why the system needs to think differently about safety, giving policymakers an insight into how their actions can create an environment where continuous safety improvement will flourish, as well as how they can help to tackle system-wide problems that hinder local improvement.

Length of Publication:  40 pages


Developing person-centred analysis of harm in a paediatric hospital: a quality improvement report

May 22, 2015

Source:  BMJ Quality & Safety 24/5 pp. 337-44

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Date of publicationMay 2015

Publication type:  Journal article

In a nutshell: Staff at Great Ormond Street Hospital developed and tested a tool specifically designed for patients and families to report harm. Processes to report harm were developed over a 10-month period. The tool was tested in different formats and it moved from a provider centric to a person-centred tool analysed in real time. Feedback to staff provided learning opportunities. Improvements in culture climate and staff reporting were noted in the short term. The integration of patient involvement in safety monitoring systems is vital to achieve safety. The testing and introduction of a self-reporting, real-time bedside tool has led to active engagement with families and patients and raised awareness.

Length of Publication:  8 pages


Improving communication with primary care to ensure patient safety post-hospital discharge

March 25, 2015

Source:  British Journal of Hospital Medicine 76/1 pp. 46-9

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Date of publication:  January 2015

Publication type:  Journal article

In a nutshell: Successful communication between hospitals and primary care is vitally important to enable continuity of care and maintain patient safety post-discharge. Discharge summaries are the simplest way for GPs to obtain information about a patient’s hospital stay. A quality improvement study was conducted with the aim of increasing the content of discharge summaries for inpatients in the authors’ department. The content of discharge summaries was reviewed in accordance with local trust guidelines. Initial results pre-intervention confirmed suboptimal content of discharge summaries. Post-intervention results showed each component of discharge summaries improved in terms of content, with six of eight components having a statistically significant (P<0.05) increase. This was maintained after 12 months. Simple, intensive educational sessions can lead to an improvement in discharge summaries and communication with primary care.

Length of Publication:  4 pages

Some important notes: Please contact your local NHS Library for the full text of the article. Follow this link to find your local NHS Library


Development and measurement of perioperative patient safety indicators

March 25, 2015

Source:  British Journal of Anaesthesia [Epub ahead of print]

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Date of publication:  February 2015

Publication type:  Journal article

In a nutshell:  Many hospitals are implementing evidence-based perioperative safety guidelines so as to improve patient safety. The authors of this study aimed to develop patient safety indicators. The RAND-modified Delphi method was used to develop a set of patient safety indicators based on the perioperative guidelines. A core group of experts systematically selected recommendations from the guidelines. An expert panel of representative professionals then appraised the recommendations against safety criteria, prioritised them and reached consensus about 11 patient safety indicators. There was great variation in guideline adherence between and within hospitals, identifying opportunities for improvement in the quality of perioperative care.

Length of Publication:  1 web page

Some important notes: Please contact your local NHS Library for the full text of the article. Follow this link to find your local NHS Library


Project JOINTS: What factors affect bundle adoption in a voluntary quality improvement campaign?

January 28, 2015

Source:  BMJ Quality & Safety 24/1 pp.38-47

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Date of publication:  January 2015

Publication type:  Journal article

In a nutshell:  This article looks at how hospital adherence to quality improvement (QI) methods and hospital engagement with a large-scale QI campaign could facilitate the adoption of an enhanced prevention bundle designed to reduce surgical site infection (SSI) rates after orthopaedic surgery. Project JOINTS (Joining Organizations IN Tackling SSIs) is a QI campaign run by the Institute for Healthcare Improvement (IHI). The campaign encouraged hospitals to implement an enhanced SSI prevention bundle. Adherence to the QI methods and hospital engagement were positively associated with complete bundle adoption.

Length of Publication:  1 web page

Some important notes: Please contact your local NHS Library for the full text of the article. Follow this link to find your local NHS Library